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Natural Product Use Among Veterans with Chronic Pain: A Qualitative Study of Attitudes and Communication with Healthcare Providers

  • Original Research: Qualitative Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Despite mixed evidence regarding the safety and efficacy of natural products, many are marketed for pain and related symptoms. Use of these products is prevalent among veterans, who have disproportionately high rates of chronic pain. To date, however, there is limited research on veterans’ beliefs and attitudes about natural products and their communication with healthcare providers about their natural product use.

Objective

To explore how veterans experiencing chronic pain make decisions about natural product use, to investigate veterans’ beliefs about the safety and efficacy of these products, and to examine veterans’ experiences discussing natural products with their providers.

Design

Qualitative sub-study conducted as a supplement to a pragmatic randomized controlled trial for chronic pain management.

Participants

Twenty veterans experiencing chronic pain who reported using natural products for pain management or related health concerns.

Approach

Qualitative interviews with veterans were conducted over the phone and audio-recorded. Interviews were guided by an original semi-structured interview guide and qualitative data were analyzed using a template-based rapid analysis technique.

Key Results

Veterans with chronic pain may perceive natural products as safer than pharmaceutical products and may prefer to use natural products. Talking with providers about natural products is important to veterans, who would like information regarding the safety and potential for interaction of natural products with pharmaceutical products. However, veterans were frequently disappointed with these conversations. Veterans felt their providers demonstrated biases against natural products, which negatively impacted patient-provider relationships.

Conclusions

Veterans wish to have more productive conversations with providers about natural products. They value providers’ open-mindedness towards natural products and transparency about limitations in their knowledge. Suggestions for how providers and healthcare systems might better support veterans interested in natural products are discussed.

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Acknowledgements:

The authors wish to acknowledge the contributions of Dan Bertenthal, MPH; Allan C. Chan, MBA, MSCIS; Tammy Lee, MPH; and Nicole McCamish, MA.

Funding

This work is supported through cooperative agreement UH3AT009765-03S1 through the Office of Dietary Supplements and the National Center for Complementary and Integrative Health, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This manuscript is a product of the NIH-DOD-VA Pain Management Collaboratory. For more information about the Collaboratory, visit https://painmanagementcollaboratory.org.

Author information

Authors and Affiliations

  1. Integrative Health Service, San Francisco VA Health Care System, San Francisco, CA, USA

    Liliana Celesia Moore MA, Nicole A. Woodruff BS, Karen H. Seal MD, MPH & Natalie Purcell PhD, MPA

  2. Northern California Institute for Research and Education, San Francisco, CA, USA

    Liliana Celesia Moore MA & Nicole A. Woodruff BS

  3. San Francisco VA Health Care System, 4150 Clement St. (11A1, T-31), San Francisco, CA, USA

    Liliana Celesia Moore MA

  4. University of California, San Francisco, San Francisco, CA, USA

    Karen H. Seal MD, MPH & Natalie Purcell PhD, MPA

  5. Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA

    Termeh Feinberg PhD

  6. VA Connecticut PRIME Center, West Haven, CT, USA

    Termeh Feinberg PhD

  7. Kelly Government Solutions, Rockville, CT, USA

    Termeh Feinberg PhD

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Correspondence to Liliana Celesia Moore MA.

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At the time of submission, Termeh Feinberg served as a federal contractor to the NIH National Center for Complementary and Integrative Health.

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Appendix

Appendix

Semi-structured interview guide

  1. 1.

    Do you have unanswered questions about using natural products for pain?

  2. 2.

    Do you think it is important for your healthcare provider to talk with you about natural product use?

  3. 3.

    Have you talked to your (VA) health care provider(s) about your use of natural products for pain or related symptoms?

    1. a

      If Yes: How did they respond?

      • For Example: Positively/Supportive, Negatively/Not Supportive, Neutral

    2. b

      If No: Why not?

  4. 4.

    Have you had difficulty getting the natural products you want to use for pain or related symptoms?

    1. a

      What factors have made it hard for you to access natural products?

    2. b

      How often would you use natural products for pain or related symptoms if the VA provided them or your insurance paid for them?

  5. 5.

    Over the past 3 months, have you used natural products in place of one or more of your pain medications?

    1. a

      What type(s)?

    2. b

      What led you to make that decision?

    3. c

      How did that go?

  6. 6.

    Do you think natural products are as effective as most medications for pain?

  7. 7.

    Do you think that natural products are generally safe?

    1. a

      Why or why not?

    2. b

      Do you think natural products are less harmful than most medications?

    3. c

      Do you have any worries or concerns about taking natural products?

  8. 8.

    Would you like to share anything else about your experience using natural products or your opinion about natural products?

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Moore, L.C., Woodruff, N.A., Seal, K.H. et al. Natural Product Use Among Veterans with Chronic Pain: A Qualitative Study of Attitudes and Communication with Healthcare Providers. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-08746-2

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